The following discusses simple ways that can easily fit into your everyday routine to help protect against rising back pain. It is important that you take the following information at face value, as it is sourced from my experience as a musculoskeletal physiotherapist. In no way should it be used to undermine the advice given to you by your doctor or other health professional. Remedial massage Northern Beaches focuses on areas of the body that are overused and stressed.
1. Good Posture
Good posture is crucial to maintain correct alignment of the joints and surrounding musculature. This ensures that the forces transmitted through the body are distributed in a way that is most effective for the body and requires the least amount of effort.
It is poor posture that results in shortened (hypertonic) and elongated (phasic) muscles. Their relative attachments to the joints can exert a traction force on the joint and effectively, pull it out of alignment. This is when pain occurs, due to the stresses of movement being transmitted through the wrong points on the body. The best example for back pain is the role of the glutes (buttock) muscles. As a group, the glutes allow for stabilisation of the lower spine, in addition to controlling movement of the pelvis and therefore, the transmission of forces from the upper body and core, to the lower limbs. In many people, the glutes are tight and in most cases, underdeveloped in terms of strength. The body therefore, seeks out a compensation by utilising the spinal extensors- the two thick columns of muscle, running up either side of the spine. Over time, these muscles become overworked and fatigued, which starts to pull on the lower (lumbar) spine, thus producing low back pain. Furthermore, these forces can become transmitted further up the spine, since the body seeks out further compensation by passing the workload of the body, up the path of least resistance.
Of course, it is all well and good to talk about good posture and the benefits of it- but what constitutes a good posture? If you look around you, you can see that every person has a different anatomy, body shape and therefore, posture. Some are congenital (you are born with it) and others are the result of environmental stresses (i.e. being hunched over a desk for 8 hours a day). However, everyone can make a difference to their own posture, whilst working with what nature provided. The most simplistic way to do this is to maintain an open, upright stance. By using the image of a string, exiting from the top/ crown of the skull and pulling upwards, you can instantly engage your core and activate those underused tummy muscles. You should be able to feel in this position, that the tummy muscles are held in tight- it is important that you are simply not sucking in the stomach. You should be able to adopt and maintain normal breathing in this position. Try walking tall, with your shoulders back- this places the mid spine (thoracic region) into extension, which helps to combat the effects of that slumped, round-shouldered posture we tend to adopt habitually, all day long. By doing this, you are helping to strengthen the core muscles and facilitate deep breathing- also, its surprising how much taller and confident you will appear to passersby!
2. A strong Core
There are a whole host of exercises on the market, claiming to strengthen the core and abdominal muscles. However, these are often tricky to master and take a lot of time investment. The best and most time effective way to strengthen the muscles and at a later stage, get them to engage voluntarily (without having to think about it) is to use them in our every day activities.
This involves adopting a good, tall posture (see section 1) whilst standing, walking and sitting. If you think about how many hours a week you spend doing these activities, you can soon clock up a lot of hours of ‘core’ time. Also, this approach has the added benefit of mimicking exactly, the functional activities you do in everyday life, so the muscles will be trained in a functional manner- much different to the traditional crunch method used in the gym.
3. Keep Moving
When experiencing back pain, it is in our nature to try avoid movement at all costs and walk around like a stiff board. The important thing to know about backs however, is that a prolonged avoidance of movement, in most cases, can be detrimental and compound the original problem.
By not moving for a prolonged period, the joints and muscles fail to receive their normal movement stimulus and can become very stiff, very quickly. Once the initial pain has subsided therefore, you are left with a very sore and painful back, simply from the fact that the joints and muscles haven’t been moved. This again feeds into the ‘fear avoidance’ cycle of movement and manifests as a loss of movement and an ongoing feeling of ‘tightness’ in the spine.
The best and most simplistic way to gauge your activity level when experiencing back pain, is to lead by your symptoms. It is important that during your episode of pain, you find a happy medium- somewhere between rest and activity- where you are able to continue to move the back, but not to a point where the pain is excruciating. If you move too much into pain, this promotes a reflex response in the muscles, which can lead to further tightening and even muscle spasm.
Visualise a scale from zero to ten (zero = no pain and ten = worst pain possible). It is important, in the early stages to keep as low a pain score as possible, whilst maintaining as close to normal movement of the spine as possible. This is the level where your activity is unable to aggravate your back pain further and therefore, give it that all important window of time to settle.
Simple changes to the ways in which you choose to perform an activity or the length of time, for which you choose to do it are important factors, able to be manipulated to maintain those crucial low pain scores. Use a trial and error technique to pinpoint your own happy medium and be careful not to push it on the days where your symptoms appear more settled than usual. Giving into this temptation can leave you feeling very sore and sorry for yourself the following morning!
4. Heat and Ice therapy
I often get asked “do I use ice or heat therapy for my back pain?”. Obviously, the sensation of heat is preferrable to that of ice and therefore, most people opt to use heat as a first port of call. However, it is important that you select either of these therapies, with thought to what best suits the stage your back pain.
For example, for pain that comes of suddenly and is sharp and aggressive in nature, it is important in the first few days to use ice therapy to limit inflammation at the affected area. Apply a pack of frozen peas, wrapped in a towel directly over the area of pain for ten minutes at a time and repeat this every 3-4 hours- limit this time if you are known to suffer an adverse reaction to cold or suffer from circulatory problems.
Differentially, for chronic back pain (dull, longstanding pain) heat should used primarily to help increase blood flow to the area and therefore, help to stimulate the healing response and soften tight muscles. Sometimes your therapist may recommend contrast therapy- a mixture of heat and ice applied to the musculature and site of pain, respectively. Just make sure you don’t attempt to apply them at the same time or you will end up with a soggy carpet at the end of it!
5. Know when to take it further
Sometimes, the steps we take to self-manage our back pain aren’t enough. It is therefore, advisable that when pain is unrelenting or you are experiencing other symptoms alongside your back pain, you make an appointment with your GP. During your consultation, your GP will take a history from you, asking you questions about your pain and examine your movement. It may be that you will be prescribed some pain relief medication or receive a referral to a physiotherapist.
The most important thing is that you don’t ignore the problem and hope that it will go away by itself. In most cases, people who are referred for physiotherapy may have had a quicker and easier recovery if they had sought consultation with their GP, earlier. By ignoring your back problem, you are giving it a chance to manifest, which could lead to a longer recovery time.
6. Where can i find out further information?
For further information and advice regarding back pain or other physio related queries, please go to https://polestarpilates.com.au/service/physiotherapy/ and post your query on our interactive forum. We shall endeavour to answer it as soon as possible.
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